Image Description
Septic arthritis is a rare but serious complication of gout. The clinical presentation of both is similar consisting of pain, redness and swelling of the joint. Prompt aspiration of synovial fluid for early diagnosis and treatment is necessary as septic arthritis can rapidly destroy the articular cartilage and cause significant disability and even death. This biopsy of periarticular soft tissues from a patient with gout shows predominantly acute inflammatory infiltrate.
Image courtesy of: Dr. Ibrahim Zardawi; used with permission.
About the Disease
Crystal-induced arthritis is a group of acute and chronic inflammatory joint disorders caused by deposition of crystalline material within and around the joints. The prototypic example is gout. Endogenous Crystals: The crystals may be monosodium urate (Gout), calcium pyrophosphate dehydrate (Pseudogout), or calcium phosphate. Exogenous Crystals: The exogenous material that may trigger arthritis include corticosteroids, talcum, and biomaterials used in joint prosthesis (silicone, polyethylene, and methyl methacrylate). The underlying metabolic abnormality in gout is hyperuricemia. High plasma urate levels lead to supersaturation of synovial fluid which is a poor solvent for monosodium urate (MSU). The lower temperature in peripheral joints further decreases solubility and promotes crystal formation. Materials in and around joints, including collagen fibers, chondroitin sulfate, proteoglycans and cartilage fragments act as nuclei for crystals. Once deposited, the MSU crystals trigger cytokine-mediated tissue injury and inflammation that eventually destroys the articular cartilage.